Provider Demographics
NPI:1033476775
Name:NSAMENKA, MARY-NIVES
Entity Type:Individual
Prefix:
First Name:MARY-NIVES
Middle Name:
Last Name:NSAMENKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7053
Mailing Address - Country:US
Mailing Address - Phone:202-269-1619
Mailing Address - Fax:202-683-6739
Practice Address - Street 1:1713 MALLARD CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7053
Practice Address - Country:US
Practice Address - Phone:202-269-1619
Practice Address - Fax:202-683-6739
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker